Reliability of Automated Intracranial Volume Measurements by Synthetic Brain MRI in Children

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

In this article, “Reliability of automated intracranial volume measurements by synthetic brain MRI in children”, the performance of a semi-automatic measurement of intracranial volumes, especially CSF volume, is assessed and compared with manual expert raters. It is true and significant that automating the CSF segmentation can be very helpful in diagnosis of hydrocephalus in children. The paper is well written and detailed. I have some questions and suggestions that could improve the paper.

First, what is the ground truth to determine if a patient has hydrocephalus? Is this only determined by imaging or there are other tests to verify? Could the authors provide the sensitivity and specificity measures for both human raters and SyMRI in deciding if a subject suffers from hydrocephalus or not?

Second, the authors evaluated the CSF volume. Could a volume ratio (for example, CSF volume / ICV) be a better measure in determining hydrocephalus? If so, I would appreciate it if the authors could revise their analysis and figures accordingly.

 There are also few points that should be addressed as follows:

 

1- Please add the number of samples in Figure 2 caption.

2- Line 78: please specify which software.

3- Line 111: please specify “CSF values”, is it CSF volume values?

4- Figure 5: What does the “Difference” mean? I suppose “Manual – SyMRI”. Please specify.

 

Author Response

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Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

This paper can be accepted.

1. Remove background from the abstract.  Only main finding should be highlighted. 

2. How CSF was measured?

3. Provide more scanned images to prove the study is reproducible.

4. Figure 9 can be supplemented.

5. Conclusion need to be improved.

 

Author Response

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Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

I have the following questions about this paper:

1. When compared to conventional MRI, how can the use of automated quantitative MRI enhance the precision and repeatability of hydrocephalus diagnosis and monitoring in children, and what particular technological developments support these gains?

2.  The author may discuss how were the threshold-based segmentation of the CSF and parenchyma manually reviewed and corrected by the pediatric radiologist, and what particular standards or guidelines were followed to guarantee uniformity in the process, especially when brain lesions were present.

3. The author should explain what specific effects the design of the retrospective study has on the reliability and correctness of your findings, and what steps were taken to reduce the possibility of biases or inaccuracies resulting from the inability to appropriately evaluate some examinations backward.

4.  The author may illustrate what kind of the strengths of SyMRI are most helpful in this scenario, and how the addition of SyMRI as an add-on sequence increases the diagnostic accuracy and distinction of incipient hydrocephalus compared to traditional imaging techniques alone.

 

5.  Which techniques can be used to lower segmentation error rates in subsequent analyses? The author may include the underlying causes of the greater segmentation error rates seen in the posterior fossa, skull base, and skull vault quartiles.

Author Response

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Author Response File: Author Response.pdf

Reviewer 4 Report

Comments and Suggestions for Authors

The paper titled "Reliability of automated intracranial volume measurements by synthetic brain MRI in children" is very well written and sound paper, I recommend some points: 

try to mention the clinical indications of MRI in pediatrics patients studied. 

Write more about the existing literature in the discussion section, mention how SyMRI compares with the other modalities 

talk about the potential clinical implications of the discrepancies between the manual and the SyMRI measurements 

talk about the technical specifications of the SyMRI settings and parameters to enhance the replicability of the study 

Author Response

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Author Response File: Author Response.pdf

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

I appreciate the author's effort to respond to my questions and concerns.